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Evaluation ViewAttendees 4

Improved Use of Research Evidence
Symposia

Symposium 89 - Dimensional models of psychopathology can help CBT therapists and their patients: Findings from clinical utility studies

Saturday, November 16, 2024
12:30 PM – 2:00 PM EST
Location: Congress B, Fourth Floor, Loews Hotel
CE: 1.5

Keywords: Clinical Utility, DSM-5, Diagnosis
Level of Familiarity: Basic to moderate
Recommended Readings: Lowe, J. R., & Widiger, T. A. (2009). Clinicians’ judgments of clinical utility: A comparison of the DSM-IV with dimensional models of general personality. Journal of Personality Disorders, 23(3), 211–229. https://doi.org/10.1521/pedi.2009.23.3.211,  

Sauer-Zavala, S., Southward, M. W., Hood, C. O., Elhusseini, S., Fruhbauerova, M., Stumpp, N. E., & Semcho, S. A. (2023). Conceptual Development and Case Data for a Modular, Personality-Based Treatment for Borderline Personality Disorder. Personality Disorders, 14(4), 369–380. https://doi.org/10.1037/per0000520

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Berghuis, H., Kamphuis, J. H., & Verheul, R. (2012). Core features of personality disorder: Differentiating general personality dysfunctioning from personality traits. Journal of Personality Disorders, 26, 704-716.

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Yarkoni, T. (2010). Personality in 100,000 Words: A large-scale analysis of personality and word use among bloggers. Journal of Research in Personality, 44(3), 363–373. https://doi.org/10.1016/j.jrp.2010.04.001

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Dimensional models of psychopathology have the potential to make cognitive-behavioral therapy more potent, parsimonious, and personalized. Dimensional classification systems such as the Hierarchical Taxonomy of Psychopathology (HiTOP) and DSM-5’s Alternative Model of Personality Disorders (AMPD) point to a limited number of higher-order vulnerabilities that can serve as transdiagnostic treatment targets, leading to more efficient symptom improvement across a range of conditions.
Arguments against the transition from categorical (e.g., yes/no diagnoses of the traditional DSM system) to dimensional models of personality and psychopathology often mention a perceived lack of clinical utility of dimensional models. However, studies have shown that clinicians and patients alike benefit from a dimensional conceptualization of psychopathology. For example, patients receiving a novel, personalizable treatment for borderline personality disorder that targets the BPD-relevant domains of the AMPD (i.e., neuroticism, antagonism, disinhibition) report high satisfaction with the treatment. Patients also indicated that the treatment was validating of their identities (Stumpp et al., submitted); thus, treatments based on dimensional models promote diversity in CBT treatment at least as well as those based on categorical models. Similarly, Samuel (submitted) found that clients described case conceptualizations based on dimensional models as reflective of their uniqueness as individuals.

In addition to patient benefit, clinicians may also benefit from a shift to dimensional models of psychopathology. Clinicians from a variety of theoretical orientations have indicated their preference for dimensional models over categorical models in terms of usefulness for clinical decision making (for example, see Lowe & Widiger, 2009; Samuel, submitted). Furthermore, healthcare providers perceive HiTOP (i.e., dimensional) labels as less stigmatizing than DSM-5 (i.e., categorical) labels (Hein et al., submitted).

Although there are clearly benefits to transitioning to dimensional models of psychopathology, the shift is not without its limitations. For example, the AMPD currently assesses self- and other-impairment (e.g., identity problems) and personality trait elevations as separate criteria. To reduce complexity, identity problems may be better conceptualized as a facet of negative affectivity (Hines et al., submitted). Additionally, the field’s reliance on self-reports limits the validity of assessments from either the categorical or dimensional perspective. However, advancements in artificial intelligence could allow clinicians to assess dimensional markers of personality based on the language patients use during clinical interviews (Mays & Oltmanns, submitted).

Thus, despite areas of further research and improvement, dimensional models of personality and psychopathology often demonstrate incremental clinical utility over their categorical counterparts. Innovations in case conceptualization, assessment, and treatment have the potential to ease clinician burden and improve patient care.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Explain clinical utility of dimensional models of psychopathology from patients’ perspectives
  2. Discuss benefits to clinicians when dimensional models of psychopathology are used
  3. Identify areas of potential improvement to dimensional models
  4. Explain pros and cons of using dimensional models of psychopathology in future clinical work
  5. Use less stigmatizing language (i.e., language that reflects the dimensional nature of mental health conditions)

Presentations:

  • 12:30 PM – 2:00 PM EST
    (SYM 89) Patient Perceptions of a Modular, Personality-based Treatment for Borderline Personality Disorder

    Speaker: Nicole Stumpp, M.S. (she/her/hers) – University of Kentucky

    Co-author: Martina Fruhbauerova, M.S. – University of Kentucky

    Co-author: Shannon Sauer-Zavala, Ph.D. (she/her/hers) – University of Kentucky

  • 12:30 PM – 2:00 PM EST
    (SYM 89) Consistent Evidence That Clinicians Find Dimensional Models of Psychopathology More Useful Than Categories

    Speaker: Douglas B. Samuel, Ph.D. (he/him/his) – Purdue University

  • 12:30 PM – 2:00 PM EST
    (SYM 89) A Comparison of Stigmatizing Language Used to Describe Personality Disorders

    Speaker: Katherine E. Hein, M.S. (she/her/hers) – Oklahoma State University

    Co-author: Shakur J. Dennis, B.A. – Oklahoma State University

    Co-author: Logan Folger, M.S. – Oklahoma State University

    Co-author: Stephanie Mullins-Sweatt, Ph.D. (she/her/hers) – Oklahoma State University

  • 12:30 PM – 2:00 PM EST
    (SYM 89) Identity Disturbance and the Five-factor Model

    Speaker: Alexandra Hines, M.S. (she/her/hers) – University of Kentucky

    Co-author: Caden Maynard, B.A. – University of Kentucky

    Co-author: Sarah E. Cecil, B.A. – University of Kentucky

    Co-author: Ragan Welch, Undergraduate Student – Georgetown College

    Co-author: Kaitlyn Cooper, B.A. – University of Kentucky

    Co-author: Caitlynne Hill, B.A. – University of Kentucky

    Co-author: Madelyn Gatewood, Undergraduate Student – University of Kentucky

    Co-author: Ryleigh Bright, Undergraduate Student – University of Kentucky

    Co-author: Chloe Goodman, B.A. – University of Kentucky

    Co-author: Matthew W. Southward, Ph.D. (he/him/his) – University of Kentucky

    Co-author: Joshua Oltmanns, Ph.D. – Southern Methodist University

    Co-author: Thomas Widiger, Ph.D. – University of Kentucky

  • 12:30 PM – 2:00 PM EST
    (SYM 89) Understanding Low Agreeableness and Antagonism Through Natural Language in Clinical Interviews

    Speaker: Anton A. Mays, M.A. (he/him/his) – Xavier University

    Co-author: Joshua Oltmanns, Ph.D. – Southern Methodist University